Considine Julie, Berry Debra, Newnham Evan, Jiang Matthew, Fox Karen, Plunkett David, Mecner Melissa, Darzins Peteris, O'Reilly Mary
Geelong: School of Nursing and Midwifery and Centre for Quality and Patient Safety - Eastern Health Partnership, Deakin University, Geelong, Australia.
Eastern Health, Box Hill, Australia.
BMC Health Serv Res. 2018 Sep 14;18(1):713. doi: 10.1186/s12913-018-3527-6.
Unplanned hospital readmissions are a quality and safety indicator. In Australian, 8% to 11.1% of unplanned readmissions occur ≤1 day of acute care discharge. The aim of this study was to explore the reasons for unplanned hospital readmissions ≤1 day of acute care discharge, and determine what proportion of such unplanned hospital readmissions were potentially preventable.
A retrospective exploratory cohort design was used to conduct this two phase study. In Phase 1, organisational data from 170 readmissions ≤1 day and 1358 readmissions between 2 and 28 days were compared using the Cochran-Mantel-Haenszel test. Binary logistic regression was used to examine factors associated with unplanned readmission ≤1 day. In Phase 2, a medical record audit of 162 Phase 1 readmissions ≤1 day was conducted and descriptive statistics used to summarise the study data. Index discharges occurred between 1 August and 31 December 2015.
In Phase 1, unplanned readmissions ≤1 day were more likely in paediatric patients (< 0.001); index discharges on weekends (p = 0.006), from short stay unit (SSU) (p < 0.001) or against health professional advice (p = 0.010); or when the readmission was for a Diagnosis Related Group (p < 0.001). The significant predictors of unplanned readmission ≤1 day were index discharge against advice or from SSU, and 1-5 hospital admissions in the 6 months preceding index admission. In Phase 2, 88.3% readmissions were unpreventable and 11.7% were preventable. The median patient age was 57 years and comorbidities were uncommon (3.1%). Most patients (94.4%) lived at home and with others (78.9%). Friday was the most common day of index discharge (17.3%) and Saturday was the most common day of unplanned readmission (19.1%). The majority (94.4%) of readmissions were via the emergency department: 58.5% were for a like diagnosis and pain was the most common reason for readmission.
Advanced age, significant comorbidities and social isolation did not feature in patients with an unplanned readmission ≤1 day. One quarter of patients were discharged on a Friday or weekend, one quarter of readmissions occurred on a weekend, and pain was the most common reason for readmission raising issues about access to services and weekend discharge planning.
非计划内的医院再入院是一项质量和安全指标。在澳大利亚，8%至11.1%的非计划内再入院发生在急性护理出院后≤1天。本研究的目的是探讨急性护理出院后≤1天非计划内医院再入院的原因，并确定此类非计划内医院再入院中潜在可预防的比例。
采用回顾性探索性队列设计进行这项两阶段研究。在第1阶段，使用 Cochr an-Mantel-Haenszel检验比较了170例出院后≤1天再入院和1358例出院后2至28天再入院的机构数据。使用二元逻辑回归分析与出院后≤1天非计划内再入院相关的因素。在第2阶段，对162例第1阶段出院后≤1天的再入院病例进行了病历审核，并使用描述性统计来汇总研究数据。索引出院发生在2015年8月1日至12月31日之间。
在第1阶段，儿科患者出院后≤1天非计划内再入院的可能性更高（<0.001）；周末的索引出院（p = 0.006）、来自短期住院病房（SSU）（p < 0.001）或违背健康专业人员建议（p = 0.010）；或者再入院是因为诊断相关组（p < 0.001）。出院后≤1天非计划内再入院的显著预测因素是违背建议或从SSU出院，以及索引入院前6个月内有1至5次住院。在第2阶段，88.3%的再入院是不可预防的，11.7%是可预防的。患者的中位年龄为57岁，合并症不常见（3.1%）。大多数患者（94.4%）居家生活且与他人同住（78.9%）。周五是索引出院最常见的日期（17.3%），周六是非计划内再入院最常见的日期（19.1%）。大多数（94.4%）再入院是通过急诊科：58.5%是因为类似诊断，疼痛是再入院最常见的原因。
出院后≤1天非计划内再入院的患者中未出现高龄、严重合并症和社会孤立的情况。四分之一的患者在周五或周末出院，四分之一的再入院发生在周末，疼痛是再入院最常见的原因，这引发了关于服务可及性和周末出院计划的问题。
